Midwifery & childbirth, family

Archive for November, 2007

I’m married to a grumpy old man, everything about modern life irritates him, and very near to the top of his ‘I hate..’ list come computers. Two months ago, when his harddrive ceased driving, I thought that he was overcoming his phobia as refused the offer of my computer and demanded he had a new one. He has his new computer, and is very happy. Then Tuesday came. In I came from work, and a sad little voice emanated from his office, ‘ My printer’s not working’. As far as he was concerned it was the computer’s fault, and why not, after all it was the monitor displaying the messages informing him that things were not going too well on the printer front. After a futile half an hour of attempting to prove to him that it was the printer I finally got the message through by involving my computer in the process. So now he has a new printer, and not just any printer, this is a printer, scanner, fax and photocopier. I did all the crawling under desks to sort out the wires and then I stepped back and made him install the software, and, with much swearing he did it, successfully. This evening I came in from work, and he was virtally preening himself. This morning his computer had played up, lights were flashing and it wouldn’t let him reboot or switch off. He phoned the manufacturers support line and they talked him through troubleshooting, again successfully. It has been a tense time these last few days, with much muttering about the evil intent of today’s technology, but I think the barriers are being lowered, and hopefully the software I have bought him for his birthday will make him start to enjoy his interactions with computers.

“The main way to solve these problems is simply to improve midwife numbers“Louise Silverton, of the Royal College of Midwives

Guess the fact that 2, of our team of 7 community midwives, are leaving the profession this January won’t help the situation then. Why are they leaving? The politics, the bureaucracy, and the impossibility of providing the level of care they believe they should and so fulfill the demands of a public who have been given unrealisic expectations of today’s maternity services.

I have to say that the way some sections of the media report the problems really doesn’t help the desire to continue. My sensitive little self found the article in The Times quite upsetting. It started on accusatory note “Midwives are failing to offer proper care and reassurance during childbirth, with one in four women being abandoned during labour or soon after, a watchdog says today” with the title stating that ‘”A quarter of women are abandoned by their NHS midwives during childbirth”. This makes it sound that midwives are happy with the fact that they are unable to offer one-to-one care to women. That it is every midwives ideal scenario to start their shift with 8 women on labour ward with only 4 or 5 midwives on duty. I wish the article had been more evenhanded, and qualified the facts and figures with the causes of the failure to provide ‘best care. For example, after reporting that ‘ Only one in five women surveyed said that she had a midwife who looked after her during labour and birth, while more than two in five said that three or more staff had cared for them at different times’the journalist could have pointed out that, due to budgetary constraints, midwives are not paid if they work over their contracted hours. How often would most employees remain several hours extra on every shift if they were not being paid? The majority of midwives I have worked with will remain with a woman who is in labour if birth appears imminent but, even if he birth occurs only 30 minutes after her shift officially ended, there are still all the notes and computer entries to complete, adding at least another 45-60 minutes to the 30 minutes she has already stayed. If this is a ‘late’ shift, finishing at 21.30, it is now 23.00, she has still to travel home and her next shift might begin at 07.30 the next day. Midwives, like all other workers, do get tired. It’s all just so depressing.

So, there I was reading Homebirth Debate and I started trying to find the UC site that Dr Amy refers to. I must be particularly unobservant as I can’t discover the name, or a link, which would allow me to read the forums. Whilst searching I stumbled across this midwifery today forum, which contained the following:-

Hi my name is Lisa, I am 28weeks and I am moving to South Carolina (Spartanburg County) in the next few weeks. I have been researching UCand I absolutley want to do this.I attend breastfeeding meetings once a week and I always ask a lot of questions (questions concerning pregnancy, usually). But there are some that can’t be answered because they are not into what I believe in (as to do it the natural way). Here are some questions that I can’t seem to get answered and hope someone can help.

1. What “exactly” do I need to do to get a birth certificate? Do they need the weight and length of the baby, too?

2. Is it illegal in the state of South Carolina to do UC?3. I want to have the birth in the tub. So when the head comes out do I need to stand up, not to drown the baby?
4. *I would like to know of a herbologist or whom ever knows about such things, in this area, so that if something happens that I may havetintures to use (instead of drugs) for hemmoraging etc., or say soothing smells in the home.*5. I am Rh- I do not want the shot, which my doctor wants to give me next week at my visit, (to his surprise I am not taking that or the blood test for diabetees – I feel great!).What are your feelings on this matter?6. Where can I go to find out about positions for delivery, in case my baby is breeched?7. Should I go to Lamaze class?

8. Do I need to get out of the tub once I delivery the baby, so my body can deliver the placenta?

9. If it is a boy, I would like him to be circumsized. How long do I wait? Where do I go? and does he realy need a vitamin K shot? (I would prefer the oral vitamin K.)

10. Last but not least if something goes wrong I will go to the hospital, but will they respect my wishes as to no Hepititus B, Ointment in the eyes, PKU test, etc.? I do have a Birth Plan.

I’m sorry that it is so lengthy, but I am almost prepared in having this baby! Thanks so much!

Where do I start? I’m going to begin my saying that my first thought when I read this was ‘ This has to be a wind-up. Someone who is so clearly uninformed can not be considering UC’. Then I mused again and thought that at least she is trying to find out about the process. Logic stepped in ‘ She has access to the internet, she must have done a search.’ That was my next step and immediately I found this guide to unassisted childbirth. and these extracts from video’s . Lisa must have found these as well, why the naive questions?What has caused me so much angst? I’ll start by discussing he points that I’ve highlighted in green.I attend breastfeeding meetings once a week (crikey, is she studying for a diploma?) Why not ‘birthing classes’. If I was thinking of giving birth wihout any professional assistance I would be going to any groups, meetings I could track down which may give me a few ideas about the whole birthing experience.I want to have the birth in the tub. So when the head comes out do I need to stand up, not to drown the baby? Now I’m worried. She has an idea in her head but really knows nothing about it. This is phrased as if she believes that it would be easy to stand up as the baby’s head is being born. Does she really appreciate the effort that is involved in giving birth, the overwhelming sensations that a woman experiences? I’m not even going to touch on the dangers of a pool/tub birth if she has not done a great deal of reading/research around the subject.tintures to use (instead of drugs) for hemmoraging etc., or say soothing smells in the home Haemorrhaging. Yes, lets use a few ‘tinctures’, that should stop a haemorrhage. Let’s put this in context, we are not talking about a trickle of blood here, we are talking flood,It is estimated that as much as 600 ml of blood flows through the placenta each minute in a full-term pregnancy, that’s over a pint a minute. Okay, so Lisa could try Arnica or Bellis , but that’s assuming that the bleeding is caused by her uterus not contracting down, supposing she has sustained a huge tear which has severed a blood vessel, making her womb contract, is not going to be of much use. PPH (postpartum haemorrhage is the leading cause of maternal death worldwide. If it is a boy, I would like him to be circumsized Why? Come on Lisa, you don’t want any medicalisation to do with his birth so why have a part of him removed following his birth? It may be a religious demand, but otherwise??????I am almost prepared in having this baby No. She is no where near being prepared, and the fact that she believes that is what is so frightening.I don’t believe that all births should happen in hospital, but I do believe that having someone present who is equipped and trained to deal with any problems is desirable. There will always be times when babies are born before assistance arrives. However, in the main these births occur quickly and this generally means that all is well with the relationship between the Mum’s pelvis,the size of the baby and the ability of the uterus to contract efficiently. These are not long labours which can cause the uterus to tire and not contract down well following baby being born, births with the Mum lounging about in the bath and not knowing what to do, or births where there is a problem with the baby being too large and getting its shoulders stuck.

I wish I could meet the ‘people’ aka slime who acted in this way toward disabled veterans. I don’t care whether the victims of this disgraceful behaviour were disabled due to them being casualties of ‘war’, born with a disability, acquired as the result of illness or accident, all I know is that anyone who behaves like these s**ts toward other people deserves to be named and shamed. Come on, someone in Leatherhead must know who uses the swimming pool and is an ignorant b*****d.

My quest for the nomenclature ‘domestic goddess’ is galloping on apace. First came apple cake which was swiftly followed by Christmas cake, hot on their heels the panforte was encouraged out of it’s baking tin and then yesterday a bread pudding was produced for a disbelieving family. Youngest daughter has decided that this culinary fest is a sure sign that ‘it’s started’, the menopause. I gave her food for thought ( see I’m obsessed), by saying that I always enjoyed baking when I was pregnant, that kept her quiet.

The inevitable happened today, Louis and Jamie were muddled up. If they are not dressed in the same colour outfits they wear the same but always with Jamie in the darker shade, until today when Louis had on the darker bodysuit because the slogan indicated that he was a tiny dinosaur, the other was a baby dinosaur. In the heat of nursery uns, nipping to the shops ets, daughter acted on instinct and grabbed one twin, believed he was in need of a feed and expended much energy encouraging him to imbibe. It was only later, when one twin was extremely miserable, and the other screaming with tummy pains that other daughter realised that their Mummy had double fed one boy and the other one had not been fed for hours!

This evening has been spent ‘suturing’ a snapped canvas strap on Hubby’s golf bag. It was of upmost importance that it was done tonight as the course will be frozen in the morning which means that trolleys won’t be allowed. I don’t understand a word of it, I just knew that I had to repair it. First we had to decide what the best material would be. I needs to be strong, unbreakable, durable and at 6pm it had to be case of something readily available. I rummaged through my sewing box, ferreted about in my gardening supplies and then inspiration struck, suturing material. I always have a couple of packs of out of date sutures so I can keep my hand in and also to teach my students so I produced some for Hubby’s approval. It was tough going, literally, double layer of canvas but hopefully it will see him through his 18 holes tomorrow. As I was talking about sutures I ‘googled’ perineal suturing, hoping to find an explanatory diagram, I couldn’t find anything appropriate, but I did find this site which has medical learning aids , don’t look if you are squeamish!

One of my women is either really stupid, or very clever at manipulation. If women want to they can really ‘play’ midwives. This comes about because it may be their pregnancy, their choice, but it is up to us to ensure they receive the care.If a women doesn’t turn up to clinic we have to record it in their notes, phone them, find out why, and see them as soon as possible. Ideally this is at the next clinic, but if it’s full, as it usually is, it ends up with us visiting them at home. If they want the triple test they need a dating scan, we need to know their weight and it has to be performed within a specified time span. So, I have a woman, R, who wants the triple test. I request a dating scan. I ask her weight, she has no idea, I advise her that she needs to find out by the time she has the test (this appointment was at her home, she has no scales). Tuesday I get a call from her telling me she hasn’t had her dating scan, she could be 20 weeks, she’s desperate for the test. I go into overdrive, call the scanning department, start reading the riot act, and get stopped in full flow by the news that she had an appointment but didn’t attend. I grovelled, apologised and managed to get her a scan for the next day, that in itself is a miracle. I then phoned R, asked her why she didn’t go to her earlier appointment, she didn’t receive it. I believed her, apologised on behalf of the postal service and told her she had a scan booked the following day. She ranted, cried, said the baby could be dead. I told her I would go round and we would listen to baby. Round I went, full check-up, her partner let slip that she was feeling the baby move, we heard the heartbeat. I explained that when she knew her dates she should then see the midwife at clinic, have the blood test form completed with the scan results and have her weight entered. Today, I get a call from her, clinic is full, can’t go. Right, I’ll fill in the form and leave it for her to collect, can she read the details on the scan report and what does she weigh, I had asked her to have her weight done at the hospital when she had her scan. Can’t be done, doesn’t understand what figures I want. Okay, I’ll come round, third time in 3 weeks I knock on her door. Start filling in the form, I’ve decided to take her blood there as I’m starting to see that being responsible for her own care be alien to her and she may not get to the clinic to have them done. We get to ‘maternal weight’, and reach a dead end. She forgot to get herself weighed. I remained calm. No problem, the phlebotomist at the surgery has scales in her room. Right, have you got your routine blood forms? Do you remember which ones you need? She’d only got one, I knew had given her three. A little disagreement followed. She swore black was blue that I had only given her the one. I asked to see that one. She had a foot stool storage box full of flyers, leaflets, scraps of paper and after 5 minutes rifling though this mountain of junk mail she decided that the ultrasonographer had taken the form out of her notes. I took a deep breath, and laid the facts out, to her and in her notes. The forms will all be at the G.P’s, waiting for her. The phlebotomist will weigh her and she needs to go within the next 2 weeks. I then went straight to the surgery spoke to the phlebotomist, completed all the forms, put a comment on her surgery notes and kicked the next inanimate object I saw. I have been ‘played’, what’s the betting she doesn’t turn up for her blood test, bet a child will be ill.

Perusing other blogs I came across this one, The Local Dialect. It is written by an American who is now living in China and has just had a baby boy. She touches upon rituals associated with childbirth and, in a previous post, talks about the problems of being Rhesus negative in a country where only 1% of the population don’t have the rhesus antigen. I was surprised by the low percentage so looked up ethnicity and prevalence and found that there are very definite differences. Wikipedia quote stats showing that the 1% figure is not just in Japan and China but also Africa and amongst native American. For Caucasians the rate is 16% but those of European Basque descent have a rate of 35%. A response writen by a genetist supports these differences but it requires far more concentration to understand!

Talking of ethnicity, yet another piece of paper to be filled in when we book a woman. Apparently just ticking the box in the national pregnancy notes and filling in the box marked ethnicity on the blood forms will not suffice, no an A4 carbonated form (triplicate) has to be completed as well. Come on you bureaucrats, surely you can do better than this, there must be so many more forms, duplicating information, that you can design, (wonder how much that costs?) ensuring that I can spend even more than 30% of my time on paperwork.

I got an e-mail today, and the subject was ‘danger’. I know it’s spam, but the more I read it the more edgy I feel. This is what it says:-

I am working in a private detective agency. My name is not important. I want to warn you that I’m going to watch you and monitor your telephone line. Do you want to know who is the payer? Expect my next letter.

P.S I know, you don’t believe me. But i think the record of your telephone conversation will change your point. The record is in archive. Archive password is ******

There is an attachment which gives the impression, via it’s title, that it is a log of a phonecall. I’ll never know because I haven’t opened it, and never will as I’ve deleted it. I couldn’t care about the phone ‘tap’, I just feel horrid about the ‘watch you’ part and the ‘expect my next letter’. I just hope that other people have received the same spoof.

My aim of achieving domestic goddess status has taken another step forward, I baked my Christmas cake today. Scary stuff. Amy helped, she ‘chopped’ the almonds, we used a rolling pin, then added the flour whilst I put the eggs in and finally, after me having to rescue the cherries from her put the dried fruit in. We then had the family wish stir, those present stirred, those absent made their wishes on the phone whilst I stirred on their behalf.